Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

ACEP Now

FEBRUARY 11, 2024

Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Ahmann AJ, Capehorn M, Charpentier G, et al. Deerfield, Illinois: Takeda Pharmaceuticals America Inc; 2014. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Bansal AB, Al Khalili Y. JAMA Health Forum. 2023;4(4):e230493. 2011;2(9):484-486.

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Overdose ACS Plasma ALS 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. We therefore need to assume and rule "out" ACS — more than having to rule it "in".

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

EM Didactic

OCTOBER 7, 2018

ACS and Aortic Dissection - For ACS and Dissection, the higher CRP levels, the worse prognosis. It is not used to diagnose ACS/Dissection. 2014 Jan 1;3(1):1-5. Schillinger M, Domanovits H, Bayegan K, Hölzenbein T, Grabenw ö ger M, Thoenissen J, et al. Utility of CRP 1. Journal of Acute Disease.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

ECG & Echo Learning

OCTOBER 2, 2022

References Overgaard, Dzavik et al. Jentzer et al. J Cardiovasc Pharmacol Therap (2014). Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Gregory JS, Bonfiglio MF, Dasta JF, et al. MacGregor DA, Smith TE, Prielipp RC, et al.

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E-9-1-1 ALS Coronary Epinephrine 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. PMID: 23911630 Kim WY et al. PLoS One 2014; 9(11): e112779. PMID: 25402500 Forsythe SM et al. PMID: 25402500 Forsythe SM et al. PMID: 10631227 Mosier JM et al. Riker RR, Shehabi Y, Bokesch PM, et al. Lowe J B, Yoo M J, Patrick J O, et al. Epub 2014 Feb 17.

ED 65

ED Emergency Department ALS OR 65

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 Holcomb JB, Tilley BC, Baraniuk S, et al.

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E-9-1-1 Plasma ACS ALS 52

EMDocs

JUNE 14, 2023

Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. Iran Red Crescent Med J 16: e5072, 2014. PMID: 23163581] Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th Edition. CorePendium.

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E-9-1-1 Emergency Department Plasma ED 70

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Although this is considered a "STEMI equivalent" and the ACC/AHA guidelines even approve of thrombolytics for ACS with this ECG, the usual criteria used to alert the cath lab team of an inbound Code STEMI are not met by this ECG. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. NEJM 362(9):779; March 4, 2009.

Coronary 52

Coronary ACS ALS STEMI 52

EMDocs

JUNE 7, 2023

References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. Iran Red Crescent Med J 16: e5072, 2014. doi:10.1186/1756-0500-6-524 Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L.

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E-9-1-1 ICU Emergency Department ED 83

The Curious Clinicians

OCTOBER 4, 2023

The idea that valves may be a site of immune privilege was first offered by Mohri et al who wrote in 1967 “the reason for the delayed or absent rejection of the homologous aortic valve, especially the fresh viable valve, remains obscure. Mitchell et al examined homograft hearts after death or retransplantation. Valve Privilege.

ALS 52

ALS OR ACS 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

It encompasses the complete range of ACS, including OMI, NOMI, and coronary thromboses that have the potential to rapidly propagate and become OMI and therefore has no specificity. References 1. -- Hillinger P, Strebel I, Abacherli R, et al. Int J Cardiol 2019 2. -- Meyers HP, Bracey, Smith et al. J of Emerg Med 2021.

STEMI 52

STEMI Coronary ALS ACS 52

Don't Forget the Bubbles

JUNE 30, 2023

A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95. Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P. Laan DV, Vu TD, Thiels CA et al. Emerg Med J. 2021 Jul;38(7):488-494. Jansen, J.O.,

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E-9-1-1 FFP Plasma Emergency Department 139

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al. Krucoff et al.) ) to disastrous consequences that may deteriorate before the patient can be rushed to the cath lab. Heart 1996.

STEMI 52

STEMI ALS ACS OR 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Thelin et al. Mokhtari et al. This was NOT high sensitivity troponin, but we know from a couple studies that, even using hs-cTnI, Unstable angina still exists: These two slides come from my recent lecture on high sensitivity troponin : Slide 23 in the lecture. JACC 2016;67:1531. sensitivity, 99.5%

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

The emergency physician wasn’t sure what to make of the changes from one ECG to the next but was concerned about ACS. Rosner et al. CMAJ 2014. Int J Cardiol 2014. == MY Comment by K EN G RAUER, MD ( 10/13/2022 ): == I suspect most cases of acute OMI that occur in association with WPW — are overlooked! What do you think?

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STEMI Coronary OR ACS 52

Dr. Smith's ECG Blog

JANUARY 2, 2016

Journal of Electrocardiology 47 (2014) 655–660. In this paper, Dr. Birnbaum writes: "In patients with ACS without LVH, ST depression with negative T waves in the lateral leads is a sign of sub-endocardial ischemia and is an independent predictor of adverse outcome [11 – 13]. Armstrong EJ et al. Birnbaum Y and Mahboob A.

STEMI 52

STEMI ACS OR ALS 52

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. 15 Patients with a heart transplant can have ACS though they are unlikely to present with classic, crushing chest pain due to transplant-induced changes in cardiac innervation.

EMS 63

EMS E-9-1-1 ACS Coronary 63

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. Frost HM, Bizune D, Gerber JS, Hersh AL, Hicks LA, Tsay SV. Tonsillitis Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, et al. Community-acquired pneumonia Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, et al.

Emergency Department 143

Emergency Department E-9-1-1 ALS OR 143

ACEP Now

NOVEMBER 7, 2023

References Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Larribau R, Deham H, Niquille M, et al. Margey R, Browne L, Murphy E, et al. Kudenchuk PJ, Brown SP, Daya M, et al. Spies DM, Kiekenap J, Rupp D, et al. 20(S1):S67.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

EMDocs

FEBRUARY 12, 2024

References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 2014 Feb;19(2):168-175. Epub 2014 Jan 3. 2014 Apr;21(2):81-8. 11) Webb RK, Ralston AC, Runciman WB. 2014 Jul;20(4):236-40. 2014 Oct;31(e1):e46-9. doi: 10.1136/emermed-2014-204326. Epub 2014 Dec 31.

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Emergency Department E-9-1-1 ED ICU 94

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. O’Connell KJ, Sandler A, Dutta A, et al. O’Connell et al. O’Connell et al. Garabon JJW, Gunz AC, Ali A, Lim R. Garabon et al. Which way should we go? Crit Care Explor. 2023;5(2):e0857. Published 2023 Feb 17.

CPR 52

CPR Emergency Department ALS ICU 52

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. 2014.01.015 Motov S, Strayer R, Hayes BD, et al. 2018.01.020 Motov S, Rockoff B, Cohen V, et al. 0b013e328348bf6f Murphy CE, Raja AS, Baumann BM, et al. May 2014;32(5):421-31.

ED 98

ED E-9-1-1 Emergency Department ALS 98